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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430708612
Report Date: 12/03/2020
Date Signed: 12/08/2020 09:14:27 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:SUNNYSIDE GARDENSFACILITY NUMBER:
430708612
ADMINISTRATOR:KAREN MANDAIRFACILITY TYPE:
740
ADDRESS:1025 CARSON DRIVETELEPHONE:
(408) 730-4070
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:84CENSUS: 53DATE:
12/03/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Shelley NguyenTIME COMPLETED:
10:50 AM
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Due to COVID-19 pandemic, Licensing Program Analyst (LPA) Yatfai Eric Ng, partnered with a Health Facilities Evaluator Nurse (HFEN) Angela Pruitt from the California Department of Public Health, conducted a Case Management - Other - tele-visit via Zoom, to provide a technical assistance to prevent and mitigate the spread of COVID-19 at the facility. LPA and HFEN met with the Resident Services Director (RSD) Shelley Nguyen.

LPA and HFEN toured the facility virtually with RSD holding the telephone to show around the facility. LPA and HFEN observed staff in the facility wore masks and face shields. Hand sanitizing station was observed. COVID-19 posters were visible throughout the facility. RSD was advised on the following COVID-19 mitigation and infection control practices to prevent, contain, and mitigate the spread of COVID-19:
  • Move the covered trash bin from the outside of the isolation room to the inside
  • Procure the "step trash bin" to replace the "trash bin with a lid" that the lid needed to be picked up by hand

LPA and HFEN gave suggestions and RSD stated they would be implemented. No deficiency cited during visit.

This report was emailed to the RSD to review and to obtain a signature.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Yatfai NgTELEPHONE: (559) 410-0327
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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